Biologics for Psoriasis: Big Results or Scary Side Effects?

Like an uncaged lion, my psoriasis is roaring back all over my body. If I had any questions as to the severity of my psoriasis, then tapering and stopping Neoral (cyclosporine) over the past two months cleared those up. I expected my condition to get worse. But not this fast or widespread. Here we go again.

Appointment after appointment, my dermatologist suggested holding off on Stelara. She felt unsure about the safety profile over the long term. With little personal experience prescribing it, I would be one of her first patients to start the therapy. All that changed two weeks ago when she told me she felt more comfortable giving it to me and asked if I wanted to try it. Could it tame the lion of psoriasis without the kidney concerns that Neoral brings? Would it bring new, even potentially scarier, side effects?

I read an article in the Detroit Free Press called “Psoriasis drug promises big results, but price and side effects temper enthusiasm.” The article highlights the promise and risks of using a class of injectable medications called biologics. I’ve tried a few of them over the years such as Amevive, Humira, and Enbrel (etanercept, what I’m currently taking). One doctor quoted in the article encapsulates the dilemma I face with these medications:

“The hoopla is that with these new drugs a person can get a shot that takes care of their psoriasis for three months; that’s a good thing,” said Dr. Thomas Anderson, medical director of the University of Michigan Day Treatment Center, one of 12 in the country that provides outpatient care for the skin disease.

“But as time goes on, these drugs may not be as effective in some patients,” Anderson said. “If you get an infection while you are on one of those drugs, your body may not be as capable of getting rid of it.”

Sure enough, I can tell that Enbrel has lost effectiveness after three to four years of continual use. Stelara is an option now, but it is a newer drug with a relatively shorter track record and safety profile. The article also speaks specifically to my safety concerns:

Safety warnings listed on the labels for the drugs mention the chance of serious infections, TB and cancer, and recommend that people tell doctors before filling a prescription if they have diabetes, are scheduled for major surgery, are pregnant, have heart failure, cancer or nervous system disorders, among other chronic problems.

Doctors at U-M and Detroit’s Henry Ford Hospital, among others, tell patients that biologics aren’t often the best first choice because of the problems associated with them.

“We almost always try other things first,” said Dr. Iltefat Hamzavi, a Canton dermatologist and Henry Ford Health System physician. Hamzavi limits the drugs to patients with psoriasis over 10% or more of their body, or people with arthritic psoriasis, a painful joint problem. Psoriatic arthritis usually appears between the ages of 30 and 50 and is believed to be triggered by genes, the immune system and environmental factors, according to the National Psoriasis Foundation.

The article goes on to discuss other treatments, cost, and an upcoming webcast sponsored by the National Psoriasis Foundation on “Systemics and Biologics: Risks and Rewards,” if you want to check those out.

The “try other things first” mentality is exactly where I’m at today. I am finding comfort in knowing my friends are praying for me. I am looking at less intrusive therapies such as coal tar and sunlight with a renewed interest in experimenting with diet, exercise, and relaxation. But the option of taking a shot every few months still tempts me.

What do you think about taking biologics, especially the cost and potential risks and rewards? What has been your experience using them?

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ABOUT THE AUTHOR

Howard Chang

Howard Chang has lived with severe psoriasis for more than 35 years since childhood. He is a volunteer for the National Psoriasis Foundation. Howard works as a Christian spiritual advisor and is a married...read more